National radiotherapy plan 'impossible to realise' without more funding

The Royal College of Radiologists said the benefits NHS England hopes to achieve by reorganising services into 11 regional networks from April will require “strategic funding”.

The reorganisation is intended to link-up cancer centres and led to “substantially improved outcomes, including higher cure rates”. NHS England published the service specification this month.

The members of each network have already been agreed and the document said each will have a single lead provider that will be “contractually accountable to NHS England” for delivering the new service specification.

It is understood the lead provider will be chosen through mutual agreement within the network and not through a competitive tender process. 

Although NHS England said each lead will be in place by February, HSJ was told there are concerns among trusts that the networks will struggle to meet this deadline.

Due to the financial risks and governance involved in taking on the contract, the larger providers in each network are likely to be awarded the role but it is unclear what happens if trusts cannot agree. Each network will also have to elect a chair.

The tight timeline for implementation comes after NHS England took a year to publish the service specification after an earlier consultation on it closed.

Significant concerns have also been raised about how the reconfiguration will be funded.

In its response to a consultation on the new arrangements, NHS England said:”[It has] committed to providing additional resources over a three-year period to support networks to establish.” It is not clear how much this funding will be but NHSE said it will be “tied to the delivery” of agreed regional yearly plans, which are due to be published in June.

There are also major concerns about how new IT systems, which will be needed to help link up the regional networks, will be paid for.

Jeanette Dickson, RCR vice-president of clinical oncology, said: “Better IT underpins everything needed for the networks to operate but no clear funding has been earmarked. Cancer centres are charged with delivering workforce and IT solutions themselves, which we know, with all the constraints on hospital finances and existing staff shortages, is going to be next to impossible for them to do.

“It is dangerous to assume improved connectivity can occur without centralised investment, or that local workforce solutions can be achieved without a significant boost to the number of oncologists, radiographers and medical physicists who deliver the treatment.” 

NHS England said in its consultation response: “It is acknowledged that, in some areas, networks may need to invest in IT infrastructure to reap all the benefits of greater partnership working. NHS England is committed to supporting networks [to] achieve this.”

New service demands

The new service specification said each network must implement out of hours arrangements for people requiring urgent treatment, replace equipment once it is 10 years old and ensure at least 9,000 attendances per year at each provider.

Three additional requirements around the number of cases each oncologist and/or provider must handle every year have also been included in the service specification. The document said these “may take time to fulfil and may be very challenging to meet in geographically remote areas.

“It is recognised that it is important to strike the right balance between supporting local access for service users and ensuring access to specialist expertise.”

Although the networks will be “formally established and operational” by April 2019, NHS England said they will be given “two to three years” to meet the service specification.

NHS England commissions all radiotherapy activity in England as part of its specialised commissioning programme.

The table below lists the trusts involved in each network and the cancer alliances that have been assigned to each network.